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The treatments with the strongest evidence base for EDs use collaborative weighing at the beginning of each session, but this may be challenging for patients with comorbid OCD due to their increased tendency for rigidity, reassurance seeking, perfectionism, and a decreased tolerance for uncertainty. Personalized interventions should be devised to target the specific factors that maintain the patient’s disorder, such as addressing the core fears and how this impacts weight exposures (e.g., blind or viewed). Collaborative weighing is appropriate and needed for most patients. It is important to be mindful that certain aspects of providing weight information can become obsessive with this comorbidity, and engaging in hidden weighing can be useful in increasing tolerance of uncertainty related to changes in weight. Identifying and addressing compulsions and escape behaviors and encouraging the patient to abandon these behaviors and face the possibility of relapse can be beneficial for treatment in the long term.
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